Not so pure and simple: Drug checking isn't the silver bullet solution

The recent interest in drug checking at facilities in the UK comes on the back of a rise in purity of many drugs including MDMA and cocaine – with associated increases in acute risks of harm associated with these drugs. Drug checking can play an important role in alerting users to higher dose pills and purer powders, and can provide early warning about more dangerous or toxic pills when they appear. Anything that gets people thinking consciously about what they are taking and engaging with drug safety is a good thing. But knowing what’s in your drug is only ever part of the solution to using drugs more safely – and better quality, higher purity drugs are not necessarily safer.

In fact, the idea that higher purity drugs are safer than less pure drugs is a myth – whatever misty-eyed old ravers say about the glory days of Doves or Mitsubishis. They’re only safer if people know the purity of the drugs and use that information to make informed decisions about dosing. Variable purity of pills or powders creates greater danger of overdose if the purity is unknown – that’s why we believe government authorities should share as much information as possible about trends in drug adulteration and purity in their region. But knowing what’s in your drugs is only part of the solution. Knowing a bottle of vodka is 40% proof doesn’t stop people getting messed up on it.

High purity MDMA has not been associated with lower rates of harm. At Global Drug Survey, we’ve recorded an increase from 0.9% of last year MDMA users seeking emergency medical treatment in 2016 to 1.2% in 2017. Those countries with historically good quality MDMA and drug checking facilities such as the Netherlands (1.7%) did not show lower rates than countries only recently dealing with better quality drugs such as the UK (0.7%). And it’s not just MDMA. After years of widespread dissatisfaction with cocaine’s purity and the appearance of a well-defined two-tier market, with the promise of better quality cocaine for a higher price (usually about 30% more expensive), cocaine purity is going up. GDS2017 has just reported twice as many people seeking emergency medical treatment after the use of cocaine in the UK in the past three years, potentially and plausibly related to the doubling in the purity of cocaine we’ve seen in the last five years. Again, this is not just a UK phenomenon. A similar increase has been noted in the Netherlands. Our GDS colleague Judith Noijen, based at Jellinek, recently reported an increase in people using drug checking services for their cocaine after using it. They wanted to know what was wrong with it. The answer: it was of high purity – and the anxiety, panic and paranoia they reported was just a consequence of taking too much.

But dose-related harm is one of easiest things to counter through good education. Testing a new batch by taking a small amount while you’re sober is a good start, but was still only common practice for 60% of MDMA users last year. For those who ended up in hospital last year only 20% reported having done that. In the absence of a regulated drug market the government at the very least needs not to compound the problems facing drug users who have no choice other than to purchase variable quality products from variable quality dealing sources. They should support the widespread dissemination of credible, practical harm reduction advice rather than take a zero tolerance approach.

Knowing what’s in your drug won’t abolish drug-related risk, but it’s an important part of the equation. How we go about sharing information about drug quality and how to use drugs more safely is still a work in progress. What’s clear, though, is that many governments are hamstrung by thinking that they can’t talk honestly to people about drugs while continuing to criminalise their use. This is not the case. Many governments don’t support the widespread dissemination of credible, practical harm reduction due to a perceived conflict with their support for an outdated and increasingly unhelpful prohibition-style approach to drug use. And while it’s normally adulterated drugs that create the biggest calls for drug checking and drug law reform, in our opinion, some advocates of drug checking place too much emphasis on the drug itself and not on the other mediators of drug-related harm, like the setting or environment, the cultural context of use, and individuals’ behaviour.

Dose probably remains the biggest variable and knowing as much about your drugs’ composition or purity is useful. For those who don’t have access to drug checking our advice is ‘Test-dose and wait two hours (at least)’. If you want to reduce your risk and still have fun, use less drugs less often, avoid combining drugs and avoid injecting.

We need to become much better at helping people use that information in a way that changes behaviour. Governments can help people who use drugs take responsibility by enhancing the ability of everyone involved to have honest conversations. GDS believes that drug law reform is necessary if we’re to take harm reduction seriously, but in the meantime, changing the conversation can help save lives now.

See the full Global Drug Survey 2017 report at globaldrugsurvey.com